Transgender sex workers

Transgender Prostitution refers to transgender peoples engagement in the sex industry and the performance of sexual services in exchange for money or other forms of payment. The term transgender refers to a diverse population whose gender identity or expression differs from their assigned sex at birth. Transgender women are defined as natal males with female identification or expression, and transgender men are natal females with male identification or expression. In general prostitutes appear to be at great risk for additional serious health problems related to their profession, such as physical and sexual assault, robbery, murder, physical and mental health problems, and drug and alcohol addiction. Though all prostitutes have the potential to be affected by these events, some studies suggest that street prostitutes have a higher risk for these issues. Transgender people are likely to experience high degrees of discrimination and carry the risk of facing high HIV risks, poverty, and violence during their work.

HIV risks

Sex workers have been shown to experience risk for various health conditions, including HIV and other sexually transmitted infections (STIs). People engaging in sex exchange services are likely to receive or transmit HIV or other STI's because of the likelihood of engaging in risky sexual behaviors (e.g., sex without a condom, sex with multiple partners) and substance use. The CDC reports that because data for transgender people are not uniformly collected, there is a major lack of information about HIV-positive transgender people in the United States. There is a large gap of information because of the structural barriers created by the legal structure and criminalization of sex work. This information gap is not limited to the United States. There is an urgent need for HIV data for transgender sex workers all around the world, especially in Africa, eastern Europe, and central Asia.

According to the CDC, data collected by local health departments and scientists studying transgender communities have shown high levels of HIV and racial/ethnic disparities. In a systematic review of HIV in the United States, it was found that black/African American transgender women were most likely to test HIV positive, compared to those of other races or ethnicities. 56% of black/African American transgender women had positive HIV test results compared to 17% of white or 16% of Hispanic/Latina transgender women. Transgender sex workers (specifically transgender women) have a higher risk of carrying or contracting HIV. From the data collected it has been estimated that as many as 1-in-4 transgender female sex workers are HIV-positive. It has been proposed that prevention and HIV testing programs for transgender individuals could reduce potential risk for infection while also help identify HIV-positive transgender sex workers who are not aware of their status.

Healthcare service

Experiences of discrimination in a healthcare setting may delay a sex worker's willingness to seek medical care in the future. Refusing to seek medical treatment for seemingly minor medical issues may lead to issues becoming more serious, difficult to treat, or even life-threatening. Insensitivity from health care professionals has been cited as a reason that sex education and medical services are not accessed. Reports of insensitive behavior among health care providers (e.g., referring to transgender women as “he” and “him” and not acknowledging or respecting their identity) suggest that some services are lacking in terms of provision of culturally sensitive interactions and possible provisions of trans health care. In addition to the health care problems experienced by transgender men and women, traditional health care plans do not always cover the costs relative to transitioning, which may lead to men and women resorting to alternative methods to pay for transitioning or force them to seek out unsafe methods of making these changes such as using hormones bought off the street or sharing needles while injecting hormones.

Poverty and unemployment

Despite engaging in higher risk activity transgender sex workers are more likely to receive lower pay than other sex workers. Many may have a history of homelessness, unemployment, incarceration, mental health issues, violence, emotional/physical/sexual abuse, and drug use. Lack of economic opportunities and discrimination may lead to transgender persons entering prostitution in order to generate income for rent, drugs, medicines, hormones, or gender-related surgeries.

In addition to the laws used against male and female sex workers, laws prohibiting cross-dressing or impersonation of another sex are used to suppress their activity. Outside the sex industry, there are no explicit legal protections on a federal level for transgender workers based on gender identity/expression and only 17 states and the District of Columbia offer these protections. This lack of legal protection places transgender workers in a position to have higher rates of unemployment and greater risk of poverty.

Violence

Transgender people are likely to experience high levels of violence and harassment from strangers, people in the home, or people they know. This high vulnerability also carries the possibility of facing repeated victimization over time. There is also a high prevalence of sexual assault and rape starting at a young age. In the United States the most common finding across self-surveys and needs assessments is that about 50% of transgendered people report unwanted sexual activity. The majority of perpetrators of sexual violence are people who are known to the victim, including partners and family members.

Participating in the sex industry comes with a higher risk of experiencing violence. Sex workers work in a variety of settings and are often open to exploitation, harassment, and physical and sexual abuse from clients, managers, and police. According to self-reported surveys from sex workers in the U.S. most unwanted sexual violence has come from clients. This violence may be motivated by perpetrators hatred or negative attitudes toward transgender people. Self reported surveys have become a major form of data collection on sex worker violence in part due to research by Departments of Health or social service organizations. Since these institution have a large focus on data pertaining to sexual activity there are more reports relative to sexual violence in comparison to other forms of violence. These experiences are not always reported to the police which can affect crime reporting rates. The cause of this may be due to mistrust of the police or fear of discrimination.